Provider Demographics
NPI:1043786221
Name:LEWIS, MARSHA M (MPH, RDN, CDE, LD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MPH, RDN, CDE, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4206
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-8390
Practice Address - Street 1:908 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4206
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-8390
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered